TDR-TB must be classified separately, say experts

The World Health Organisation (WHO) does not approve of the term TDR or Totally Drug Resistant tuberculosis.

So, while the BMC is following WHO guidelines on the disease, tuberculosis experts say cases that are resistant to all known anti-TB drugs should be classified separately because more such cases will result in the transmission of the resistant strain of the disease in the community.

The civic body, which swung into action post the discovery of the severe form of drug resistant tuberculosis, has reported 24 cases of XXDR or Extra Extensively Drug Resistant Tuberculosis, in the past year. It is not clear whether this figure includes the 12 new cases of TDR reported at Hinduja Hospital.

“These XXDR patients are resistant to more than two anti-TB drugs and we are treating them under the Revised National Tuberculosis Control Programme (RNTCP),” said Dr Mini Khetrapal, the city’s first TB officer stressing that TB patients live longer if they adhere to treatment.

Experts said mortality was eight times more in Extremely Drug Resistant (XDR) cases when compared to Multi-Drug Resistant (MDR) tuberculosis and it is even higher in XXDR. According to civic body records, around 2,085 patients suffering from MDR are under treatment since 2010.

“In my practice of two decades, drug resistance among TB patients has only worsened. Each of these patients has consulted at least four doctors and had taken around nine drugs,” said Dr Zarir Udwadia who, along with two other doctors published a paper in the Clinical Infectious Diseases journal last year documenting TDR-TB cases. Dr Udwadia was speaking on XXDR at the fourth annual national conference on HIV/Aids.

“Owing to the perceived inefficiency of the public set up, we see that 70% patients go to private doctors practising Ayurveda, Unani, homoeopathy and chest physicians. And most of these patients end up with drug resistant tuberculosis because of indiscriminate use of drugs,” said Dr Udwadia at the conference.